Medicine

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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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Subject: search.filters.subject.Adolescent

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Now showing 1 - 10 of 55
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    Auditory and visual hallucinations in an adolescent following orthotopic liver transplantation
    (Sri Lanka College of Psychiatrists, 2024-10) Chandradasa, M.; Abeyrathne, M.; Sithara, P.; Kodithuwakku, K.; Fernando, M.
    No abstract available
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    Diagnostic overlap between adolescent affective instability in borderline personality and juvenile bipolar disorder in Sri Lanka
    (Sri Lanka College of Psychiatrists, 2019) Chandradasa, M.; Fernando, W.K.T.R.; Kuruppuarachchi, K.A.L.A.
    Borderline personality disorder (BPD) and bipolar disorder (BD) could present a diagnostic challenge in the adolescent due to the presence of overlapping symptoms such as impulsivity, affective instability, and sexual arousal. Of these symptoms, affective instability is a central feature of BPD, and there is a rapid shift from the neutral affect to an intense affect, and this is associated with a dysfunctional modulation of emotions. We describe three Sri Lankan adolescents presenting with affective instability, treated with psychopharmacological agents as for BD. While BPD is characterized by transient mood shifts induced by interpersonal stressors, in BD, there are sustained mood changes. A longitudinal assessment of the symptomatic profile and collateral information clarified the diagnosis as being BPD. An examination of the nature of affective instability is vital for a proper diagnosis and provision of evidence-based treatment.
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    Prediction equation for physical activity energy expenditure in 11-13-year-old Sri Lankan children
    (MDPI Publishing, 2023) Dabare, P.; Wickramasinghe, P.; Waidyatilaka, I.; Devi, S.; Kurpad, A.V.; Samaranayake, D.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Hills, A.P.; Lanerolle, P.
    This study aimed to develop a regression equation to predict physical activity energy expenditure (PAEE) using accelerometry. Children aged 11-13 years were recruited and randomly assigned to validation (n = 54) and cross-validation (n = 25) groups. The doubly labelled water (DLW) technique was used to assess energy expenditure and accelerometers were worn by participants across the same period. A preliminary equation was developed using stepwise multiple regression analysis with sex, height, weight, body mass index, fat-free mass, fat mass and counts per minute (CPM) as independent variables. Goodness-of-fit statistics were used to select the best prediction variables. The PRESS (predicted residual error sum of squares) statistical method was used to validate the final prediction equation. The preliminary equation was cross-validated on an independent group and no significant (p > 0.05) difference was observed in the PAEE estimated from the two methods. Independent variables of the final prediction equation (PAEE = [0.001CPM] - 0.112) accounted for 70.6% of the variance. The new equation developed to predict PAEE from accelerometry was found to be valid for use in Sri Lankan children.
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    Pyrexia of unknown origin (PUO) and the cost of care in a tertiary care institute in Sri Lanka
    (BioMed Central, 2023) Premathilaka, R.; Darshana, T.; Ekanayake, C.; Chathurangani, K.C.; Mendis, I.; Perinparajah, S.; Shashiprabha, M.; Nishshanka, S.; Tilakaratna, Y.; Premawardhena, A.
    BACKGROUND: Despite advancements in diagnostic technology, pyrexia of unknown origin (PUO) remains a clinical concern. Insufficient information is available regarding the cost of care for the management of PUO in the South Asian Region. METHODS: We retrospectively analyzed data of patients with PUO from a tertiary care hospital in Sri Lanka to determine the clinical course of PUO and the burden of the cost incurred in the treatment of PUO patients. Non-parametric tests were used for statistical calculations. RESULTS: A total of 100 patients with PUO were selected for the present study. The majority were males (n = 55; 55.0%). The mean ages of male and female patients were 49.65 (SD: 15.55) and 46.87 (SD: 16.19) years, respectively. In the majority, a final diagnosis had been made (n = 65; 65%). The mean number of days of hospital stay was 15.16 (SD; 7.81). The mean of the total number of fever days among PUO patients was 44.47 (SD: 37.66). Out of 65 patients whose aetiology was determined, the majority were diagnosed with an infection (n = 47; 72.31%) followed by non-infectious inflammatory disease (n = 13; 20.0%) and malignancies (n = 5; 7.7%). Extrapulmonary tuberculosis was the most common infection detected (n = 15; 31.9%). Antibiotics had been prescribed for the majority of the PUO patients (n = 90; 90%). The mean direct cost of care per PUO patient was USD 467.79 (SD: 202.81). The mean costs of medications & equipment and, investigations per PUO patient were USD 45.33 (SD: 40.13) and USD 230.26 (SD: 114.68) respectively. The cost of investigations made up 49.31% of the direct cost of care per patient. CONCLUSION: Infections, mainly extrapulmonary tuberculosis was the most common cause of PUO while a third of patients remained undiagnosed despite a lengthy hospital stay. PUO leads to high antibiotic usage, indicating the need for proper guidelines for the management of PUO patients in Sri Lanka. The mean direct cost of care per PUO patient was USD 467.79. The cost of investigations contributed mostly to the direct cost of care for the management of PUO patients.
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    Gender dysphoria and morbid sexual jealousy in an adolescent.
    (Kandy Society of Medicine, 2022) Rathnayake, L.C.; Kuruppuarachchi, C.; Abeyrathne, M.; de Silva Rajaratne, P.K.D.H.J.L.; Chandradasa, M.; Kuruppuarachchi, K.A.L.A.
    Gender dysphoria is the psychological distress that occurs when an individual’s biologically determined sex and gender identity do not align. Jealousy is likely to occur in any form of intimate partnership, irrespective of sexual orientation. Jealousy in a relationship is affected by sociocultural variables, an individual’s sense of masculinity, femininity, and other factors. We report an 18-year-old assigned female at birth with gender dysphoria presenting with jealous-type delusional disorder. We found no previous reporting of morbid jealousy in adolescents with gender dysphoria.
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    Child and Adolescent Mental Health Services (CAMHS) in a lower-middle income country: A survey from Sri Lanka.
    (SAGE Publications, 2023) Rohanachandra, Y.M.; Chandradasa, M.; Dahanayake, D.M.A.
    No abstract available
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    Risk factors for deliberate self-harm in young people in rural Sri Lanka: a prospective cohort study of 22,000 individuals
    (Sri Lanka Medical Association, 2021) Fernando, K.; Jayamanna, S.; Weerasinghe, M.; Priyadarshana, C.; Ratnayake, R.; Pearson, M.; Gunnell, D.; Dawson, A.; Hawton, K.; Konradsen, F.; Eddleston, M.; Metcalfe, C.; Knipe, D.
    Background: Over 90% of youth suicide deaths occur in low- and middle-income countries. Despite this relatively little is known about risk factors in this context. Aims: Investigate risk factors for deliberate self-harm (non-fatal) in young people in rural Sri Lanka. Methods: A prospective cohort study of 22,401 individuals aged 12-18 years with complete data on sex, student status, household asset score, household access to pesticides and household problematic alcohol use. Deliberate self-harm was measured prospectively by reviewing hospital records. Poisson regression estimated incidence rate ratios (IRRs) for the association of risk factors with deliberate self-harm. Results: Females were at higher risk of deliberate self-harm compared to males (IRR 2.05; 95%CI 1.75 – 2.40). Lower asset scores (low compared to high: IRR 1.46, 95%CI 1.12 - 2.00) and having left education (IRR 1.61 95%CI 1.31 – 1.98) were associated with higher risks of deliberate self-harm, with evidence that the effect of not being in school was more pronounced in males (IRR 1.94; 95%CI 1.40 – 2.70) than females. There was no evidence of an association between household pesticide access and deliberate self-harm risk, but problematic household alcohol use was associated with increased risk (IRR 1.23; 95%CI 1.04 – 1.45), with evidence that this was more pronounced in females than males (IRR for females 1.42; 95%CI 1.17 – 1.72). There was no evidence of deliberate self-harm risk being higher at times of school exam stress. Conclusion: Indicators of lower socioeconomic status, not being in school, and problematic alcohol use in households, were associated with increased deliberate self-harm risk in young people.
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    It’s normal to drink, isn’t it? a qualitative study on factors influencing adolescent drinking in Sri Lanka
    (Sri Lanka Medical Association, 2021) Athauda, L.K.; Pereis-John, R.; McCool, J.; Ameratunga, S.; Wickremasinghe, A.R.
    Introduction and Objectives In Sri Lanka, adolescent drinking behaviour has been linked to parental, family influence as well as culture and living location. While proximal level social determinants play an important part in influencing adolescent drinking, determinants operating at the distal level have not been discussed adequately. This study aimed to describe the factors influencing adolescent drinking among school going adolescents in the Colombo District. Methods Focus Group Discussions (FGD) were conducted separately for males and females in selected Public Health Midwife (PHM) areas in the Colombo District. A semi structured interview guide facilitated the discussion. Transcripts were translated, transcribed and managed on NVivo 12. Inductive thematic analysis was used to interpret the ideas expressed in the FGDs. Results Fifty adolescents (24 females and 26 males) aged between 16-17 years participated in eight FGDSs. The findings elaborate one overarching theme: it’s normal to drink, isn’t it? Media, culture and society contributed towards building social norms around adolescent drinking. Based on the perception of normalcy around drinking, adolescents were inclined to test their limits and experiment with alcohol, while being influenced by peers. However, they also experienced some restraints, in terms of law, family and culture, which made them question the normalcy around drinking. Conclusion Adolescents engage in social learning, through their distal environment which creates norms and aspirations. Peer engagement facilitates social capital which also contributes towards their decisions to drink. Distal level social determinants are important contributory factors of adolescent alcohol use. Restrictions within this environment may restrict their drinking
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    Experience of required foreign specialist training: The lived experiences of Sri Lankan trainee child and adolescent psychiatrists in Australia
    (Elsevier, 2021) Chandradasa, M.; Dahanayake, D.; Rohanachandra, Y.
    No Abstract Available
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    Translation, cultural adaptation and validity of the Adolescent Sedentary Activity Questionnaire among school children aged 14-15 years
    (College of Community Physicians of Sri Lanka, 2020) Godakanda, I.; Abeysena, C.; Lokubalasooriya, A.
    INTRODUCTION: Sedentary behaviour is a risk factor for several diseases. Validation of questionnaires on sedentary activity is a great challenge. OBJECTIVES: To translate, culturally adapt and validate the Adolescent Sedentary Activity Questionnaire (ASAQ) among school children. METHODS: Back translation method was used to translate ASAQ into Sinhala language (ASAQ-S). Cultural adaptation and judgmental validity were ensured using a panel of experts. Criterion validity was assessed by comparing ASAQ-S data with the reference standard, which was the ActiGraph GT1M accelerometer worn on the waist. The study population consisted of 42 school children aged 14-15 years. Sedentary activity time was taken from the accelerometer recorded data as total hours per day. The ASAQ-S has 14 items and then total sedentary time was calculated by summing up the activities of all seven days. Intra-class correlation coefficient (ICC) and 95% confidence interval (CI) were calculated. RESULTS: The average sedentary time was 11.7 (SD=3.4) hours per day recorded by an accelerometer and from the ASAQ-S 9.0 (SD=2.3) hours per day. An ICC for total sedentary activity time between the accelerometer and ASAQ-S was 0.52 (95% CI=0.08, 0.78) and Pearson correlation coefficient was 0.55 (p<0.01). CONCLUSIONS: The validity of ASAQ-S was satisfactory and can be used as a tool to assess adolescent sedentary behaviour. KEYWORDS: Adolescence, Cultural, Questionnaire, Reliability, Sedentary, Validity
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